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Central Nervous System Intraoperative Cytopathology pp 3–14Cite as

Introduction to CNS Intraoperative Cytopathology

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Part of the book series: Essentials in Cytopathology ((EICP,volume 13))

Abstract

Even in the current age of advanced neuroimaging and image-guided biopsies, intraoperative consultation is essential for evaluating CNS lesions and providing firm grounds for decision making and guide surgical approach. Likewise, intraoperative consultation is necessary to avoid non-diagnostic biopsies by confirming that the specimen obtained is adequate for an accurate final diagnosis. Intraoperative cytology is a rapid diagnostic modality with >90% diagnostic accuracy. This chapter reviews this topic and also includes a historical overview of the squash/smear technique and a summary of the 2016 updated WHO classification of the CNS tumors.

Nothing can be a greater value to a neurosurgeon than the ability to visualize, immediately, from the gross appearances of a tumor what will be its histological nature. Too great emphasis cannot be laid on this.

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Suggested Reading

  • Agrawal M, Chandrakar SK, Lokwani D, Purohit MR. Squash cytology in neurosurgical practice: a useful method in resource-limited setting with lack of a frozen section facility. J Clin Diagn Res. 2014;8:FC09–FC012.

    PubMed  PubMed Central  Google Scholar 

  • Bleggi-Torres LF, de Noronha L, Schneider Gugelmin E, Martins Sebastião AP, et al. Accuracy of the smear technique in the cytological diagnosis of 650 lesions of the central nervous system. Diagn Cytopathol. 2001;24:293–5.

    Article  CAS  Google Scholar 

  • Brainard JA, Prayson RA, Barnett GH. Frozen section evaluation of stereotactic brain biopsies. Diagnostic yield at the stereotactic target position in 188 cases. Arch Pathol Lab Med. 1997;121:481–4.

    CAS  PubMed  Google Scholar 

  • Brommeland T, Lindal S, Straume B, Dahl IL, Henning R. Does imprint cytology of brain tumors improve intraoperative diagnoses? Acta Neurol Scand. 2003;108:153–6.

    Article  CAS  Google Scholar 

  • Cahill EM, Hidvegi DF. Crush preparations of lesions of the central nervous system. A useful adjunct to the frozen section. Acta Cytol. 1985;29:279–85.

    CAS  PubMed  Google Scholar 

  • Di Stefano D, Scucchi LF, Cosentino L, Bosman C, Vecchione A. Intraoperative diagnosis of nervous system lesions. Acta Cytol. 1998;42:346–56.

    Article  Google Scholar 

  • Dudgeon LS, Patrick CV. A new method for the rapid microscopical diagnosis of tumors: With an account of 200 cases so examined. Brit J Surg. 1927;15:250–61.

    Article  Google Scholar 

  • Eisenhardt L, Cushing H. Diagnosis of intracranial tumors by supravital technique. Am J Pathol. 1930;6:541–2.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Firlik KS, Martinez AJ, Lundsford LD. Use of cytological preparations for the intraoperative diagnosis of stereotactically obtained brain biopsies: A 19-year experience and survey of neuropathologists. Neurosurgery. 1999;91:454–8.

    Article  CAS  Google Scholar 

  • Folkerth RD. Smears and frozen sections in the intraoperative diagnosis of central nervous system lesions. Neurosurg Clin North Am. 1994;5:1–18.

    Article  CAS  Google Scholar 

  • Ghosal N, Hegde AS, Murthy G, Furtado SV. Smear preparation of intracranial lesions: A retrospective study of 306 cases. Acta Cytopathol. 2011;39:582–92.

    Article  Google Scholar 

  • Goel D, Sundaram C, Paul TR, Uppin SG, et al. Intraoperative cytology (squash smear) in neurosurgical practice - pitfalls in diagnosis experience based on 3057 samples from a single institution. Cytopathology. 2007;18:300–8.

    Article  CAS  Google Scholar 

  • Guarda LA. Intraoperative cytologic diagnosis: evaluation of 370 consecutive intraoperative cytologies. Diagn Cytopathol. 1990;6:235–42.

    Article  CAS  Google Scholar 

  • Hamasaki M, Chang KHF, Nabeshima K, Tauchi-Nishi PS. Intraoperative squash and touch preparation cytology of brain lesions stained with H+E and Diff-Quik™. A 20-year retrospective analysis and comparative literature review. Acta Cytol. 2018;62:44–53.

    Article  CAS  Google Scholar 

  • Hayden R, Cajulis RS, Frias-Hidvegi D, Brody BA, Yu G, Levy R. Intraoperative diagnostic techniques for stereotactic brain biopsies: cytology versus frozen-section histopathology. Stereotact Funct Neurosurg. 1995;65:187–93.

    Article  CAS  Google Scholar 

  • Iqbal M, Shah A, Wani MA, Kirmani A, Ramzan A. Cytopathology of the central nervous system. I. Utility of crush smear cytology in intraoperative diagnosis of central nervous system lesions. Acta Cytol. 2006;50:608–16.

    Article  Google Scholar 

  • Ironside JW. Update on central nervous system cytopathology. II. Brain smear technique. J Clin Pathol. 1994;47:683–8.

    Article  CAS  Google Scholar 

  • Jaiswall S, Mukul V, Jaiswal AK, Behari S. Intraoperative squash cytology of central nervous system lesions. A single center study of 326 cases. Diagn cytopathol. 2012;40:104–12.

    Article  Google Scholar 

  • Jane JA, Bertrand G. A cytological method for the diagnosis of tumors affecting the central nervous system. J Neuropath Exp Neurol. 1962;21:400–9.

    Article  CAS  Google Scholar 

  • Jane JA, Yashon D. Cytology of tumors affecting the nervous system. Springfield, Illinois: Charkles C Thomas; 1969.

    Google Scholar 

  • Kishore S, Bhardwaj A, Kusum A, Thakur B, Kaushik S, Sharma N. Intraoperative squash cytology of central nervous system and spinal cord lesions with histological correlation. Ann Pathol Lab Med. 2016;3:61–72.

    Google Scholar 

  • Krishnani N, Kumari N, Behari S, Rana C, Gupta P. Intraoperative squash cytology: accuracy and impact on immediate surgical management of central nervous system tumors. Cytopathology. 2012;23:308–14.

    Article  CAS  Google Scholar 

  • Lacruz CR, Escalona J. Diagnóstico citológico de los tumores del sistema nervioso central. Barcelona: César Viguera; 2000.

    Google Scholar 

  • Liwnicz BH, Henderson KS, Masukawa T, Smith RD. Needle aspiration cytology of intracranial lesions: A review of 84 cases. Acta Cytol. 1982;26:779–86.

    CAS  PubMed  Google Scholar 

  • Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, editors. WHO classification of tumours of the central nervous system (Revised 4th ed). Lyon: International Agency for Research on Cancer (IARC); 2016a.

    Google Scholar 

  • Louis DN, Perry A, Reifenberger G, von Deimling A, et al. The 2016 world health organization classification of tumors of the central nervous system: a summary. Acta Neuropathol. 2016b;13:803–20.

    Article  Google Scholar 

  • Marshall LF, Adams H, Doyle D, Graham DI. The histological accuracy of the smear technique for neurosurgical biopsies. J Neurosurg. 1973;39:82–8.

    Article  CAS  Google Scholar 

  • Martinez AJ, Pollack I, Hall WA, Lunsford LD. Touch preparations in the rapid intraoperative diagnosis of central nervous system lesions. A comparison with frozen sections and paraffin-embedded sections. Mod Pathol. 1988;1:378–84.

    CAS  PubMed  Google Scholar 

  • McMenemey WH. An appraisal of smear diagnosis in neurosurgery. Am J Clin Pathol. 1960;33:471–9.

    Article  Google Scholar 

  • Mitra S, Kumar M, Sharma V, Mukhopadhyay D. Squash preparation. a reliable diagnostic tool in the intraoperative diagnosis of central nervous system tumors. J Cytol. 2010;27:81–5.

    Article  Google Scholar 

  • Morris AA. The use of the smear technique in the rapid histological diagnosis of tumors of the central nervous system. Description of a new staining method. J Neurosurg. 1947;4:497–504.

    Article  CAS  Google Scholar 

  • Mouriquand C, Benabid AL, Breyton M. Stereotaxic cytology of brain tumors. Review of an eight year experience. Acta Cytol. 1987;31:756–65.

    CAS  PubMed  Google Scholar 

  • Nanarng V, Jacob S, Mahapatra D, Mathew JE. Intraoperative diagnosis of central nervous system lesions: comparison of squash smear, touch imprint, and frozen section. J Cytol. 2015;32:153–8.

    Article  Google Scholar 

  • O'Neill KS, Dyer PV, Bell BA, Wilkins PR, Uttley D, Marsh HT. Is perioperative smear cytology necessary for CT-guided stereotaxic biopsy? Br J Neurosurg. 1992;6:421–7.

    Article  CAS  Google Scholar 

  • Ostertag CB, Mennel HD, Kiessling M. Stereotaxic biopsy of brain tumors. Surg Neurol. 1980;14:275–83.

    CAS  PubMed  Google Scholar 

  • Plesec TP, Prayson RA. Frozen section discrepancy in the evaluation of central nervous system tumors. Arch Pathol Lab Med. 2007;131:1532–40.

    PubMed  Google Scholar 

  • Plesec TP, Prayson RA. Frozen section discrepancy in the evaluation of nonneoplastic central nervous system samples. Ann Diagn Pathol. 2009;13:359–66.

    Article  Google Scholar 

  • Reyes MG, Homsi FM, McDonald LW, Glick RPI. smears, and frozen sections of brain tumors. Neurosurgery. 1991;29:575–9.

    Article  CAS  Google Scholar 

  • Roessler K, Dietrich W, Kitz K. High diagnostic accuracy of cytologic smears of central nervous system tumors. A 15-years’ experience based on 4172 patients. Acta Cytol. 2002;46:667–74.

    Article  Google Scholar 

  • Russell DS, Krayenbühl H, Cairns H. The wet film technique in the histological diagnosis of intracranial tumors; a rapid method. J Path Bac.t. 1937;45:501–5.

    Article  Google Scholar 

  • Savargaonkar P, Farmer PM. Utility of intra-operative consultations for the diagnosis of central nervous system lesions. Ann Clin Lab Sci. 2001;31:133–9.

    CAS  PubMed  Google Scholar 

  • Shah AB, Muzumdar GA, Chitale AR, Bhagwati SN. Squash preparation and frozen section in intraoperative diagnosis of central nervous system tumours. Acta Cytol. 1998;42:1149–54.

    Article  CAS  Google Scholar 

  • Sharma S, Deb P. Intraoperative neurocytology of primary central nervous system neoplasia: a simplified and practical diagnostic approach. J Cytol. 2011;28:147–58.

    Article  Google Scholar 

  • Silverman JF, Timmons RL, Leonard JR, Hardy IM, et al. Cytologic results of fine-needle aspiration aspiration biopsies of the central nervous system. Cancer. 1986;58:1117–21.

    Article  CAS  Google Scholar 

  • Torres LFB, Collaço LM. Smear technique for the intraoperative examination of nervous system lesions. Acta Cytol. 1993;37:34–9.

    CAS  PubMed  Google Scholar 

  • Wilkerson JA, Bonnin JM. Intraoperative cytology. An adjunct to frozen sections. New York: Igaku-Shoin; 1987.

    Google Scholar 

  • Willems JGMS, Alva-Willems JM. Accuracy of cytologic diagnosis of central nervous system neoplasms in stereotactic biopsies. Acta Cytol. 1984;28:243–9.

    CAS  PubMed  Google Scholar 

  • Zhang YX, Luo KS, Liv JC, Chen Y, Chen YH, Lai RS. Cytological diagnosis of 500 cases of intracranial tumors during craniotomy. Chin J Clin Cytol. 1987;3:19–27.

    CAS  Google Scholar 

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Authors and Affiliations

  1. Professor of Pathology, Complutense University School of Medicine, Madrid, Spain

    César R. Lacruz

  2. Professor of Pathology, University Hospital Extremadura, Medical School, Badajoz, Spain

    Javier Saénz de Santamaría

  3. Pathologist, Director Ultrasound-guided Fine Needle Aspiration Service, Outpatient Pathology Associates / Precision Pathology, Sacramento, CA, USA

    Ricardo H. Bardales

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  1. César R. Lacruz
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  2. Javier Saénz de Santamaría
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  3. Ricardo H. Bardales
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Lacruz, C.R., Saénz de Santamaría, J., Bardales, R.H. (2018). Introduction to CNS Intraoperative Cytopathology. In: Central Nervous System Intraoperative Cytopathology. Essentials in Cytopathology, vol 13. Springer, Cham. https://doi.org/10.1007/978-3-319-98491-9_1

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  • DOI: https://doi.org/10.1007/978-3-319-98491-9_1

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  • Print ISBN: 978-3-319-98490-2

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